The U.S. Department of Justice has broadened its accusations that Pennsylvania courts discriminate against people with opioid use disorder by restricting access to medications widely seen in the medical community as life-saving.
The outcome of this court case — which directly involves the state Supreme Court, as well as Blair, Jefferson, Lackawanna, and Northumberland County court systems as defendants — could have major implications across the state for people who experience opioid addiction and face criminal charges.
Recently filed court documents show the opposing sides appear close to finalizing a settlement agreement. Officials representing the state court system have until the end of January to approve or reject the proposed agreement, the details of which are not available in public court documents. The DOJ has already accepted the agreement, according to a judge’s December order.
Sally Friedman of the advocacy group Legal Action Center is following the case closely. Her organization represents one of the individuals who’s alleging they were harmed by a county court’s restrictions.
She called the medication bans “extremely dangerous and counterproductive,” and said it’s “terrific that the Department of Justice is trying to bring the state court system to task on this and get them to change the way they do things.”
Through a spokesperson, officials representing the state court system and county courts involved in the case declined to comment for this story. A DOJ spokesperson also declined to comment.
A review of legal filings reveals the broad scope of the allegations in Pennsylvania. The documents show how the major dispute of the case centers on what responsibility state court leaders have over decisions made in local courts.
The agency has brought the case under the Americans with Disabilities Act. In one hearing, a DOJ attorney made a distinction between a decision a judge might make about an individual defendant versus the “blanket banning of treatment,” which the attorney argued is not allowed.
The case focuses on the three federally approved medications for opioid use disorder: buprenorphine, methadone, and naltrexone. All three medications have different effects on people who use them.
Any practitioner licensed to prescribe medications can prescribe naltrexone, which blocks the euphoric and sedative effects of taking opioids, according to an online guide from the federal Substance Abuse and Mental Health Services Administration. “There is no abuse and diversion potential with naltrexone,” the guide says.
Buprenorphine is what’s known as an opioid partial agonist. “It produces effects such as euphoria or respiratory depression at low to moderate doses,” according to another online SAMHSA guide. “With buprenorphine, however, these effects are weaker than full opioid agonists such as methadone and heroin.”
Nationally, patients can receive a buprenorphine prescription from qualified health care practitioners as part of their regular practice, such as in a primary care office visit. There are stricter regulations for accessing methadone.
Both methadone and buprenorphine alleviate withdrawal symptoms, decrease craving, and block the euphoric effects of other opioids, according to a 2019 report from the National Academies of Sciences, Engineering, and Medicine. The report cited research showing people with opioid use disorder “are less likely to die when they are in long-term treatment with methadone or buprenorphine than when they are untreated.”
James Latronica, an Allegheny County physician and president-elect of the Pennsylvania Society of Addiction Medicine, welcomes the increased scrutiny of Pennsylvania courts. He described court bans on these medications as “really dangerous” and “cruel.”
“To force patients to go against the advice of their physicians in order to avoid penalties or incarceration, I think is unethical,” he told Spotlight PA.
The case involves individual county courts and the entire state court system.
Attorneys for the DOJ claim the Supreme Court of Pennsylvania has failed to prevent local courts from implementing discriminatory policies and practices. These restrictions allegedly prevented people with opioid use disorder from having equal access to court supervision programs, including problem-solving court programs that provide alternatives to incarceration.
Under Pennsylvania’s Constitution, the state Supreme Court has “general supervisory and administrative authority over all the courts and justices of the peace” in the state’s court system. That power includes prescribing “general rules governing practice, procedure and the conduct of all courts.”
Attorneys representing the state court system have argued that the Department of Justice has failed to provide evidence of a systemic problem and that the entire system shouldn’t be held liable for the actions of local, independently elected judges.
They have also argued that the federal agency “has no business telling the Supreme Court of Pennsylvania what its supervisory duties are under the Pennsylvania Constitution or how that Court’s authority under its own state charter should be exercised.”
Allegations in more counties
The litigation began nearly two years ago when the federal agency sued Pennsylvania’s entire state court system. A federal judge dismissed that complaint in April 2023 but provided the Justice Department the opportunity to submit an amended one.
The amended DOJ complaint added the Supreme Court of Pennsylvania as a defendant, along with four county court systems: Blair, Jefferson, Lackawanna, and Northumberland.
The original 2022 complaint included descriptions of three unnamed individuals who were allegedly harmed — two in Jefferson and one in Northumberland. The amended complaint added three more people. In a separate legal filing, the Justice Department claimed there is “a high likelihood” that Pennsylvania courts have harmed others.
In Blair County, one person identified as Complainant D was accepted into the county’s drug court program in October 2021, and was forced to wean off his prescribed buprenorphine, the Justice Department alleged.
His forced withdrawal “included a stay in inpatient residential treatment, during which he had no appetite, he routinely vomited, his body twitched, and he felt like he wanted to die,” attorneys for the Justice Department alleged. “Complainant D spent the Thanksgiving holiday away from his family suffering through this forced withdrawal.”
For another individual, identified as Complainant E, the federal agency alleged Blair County’s policy led to several harms, including relapsing and “trying heroin for the first time and becoming addicted.” (Complainant E had previously used buprenorphine as part of his treatment for an addiction to painkillers that developed “after several on-the-job injuries,” according to the complaint.)
In Lackawanna County, an individual described as Complainant F was admitted to a problem-solving court in 2018 after being arrested for driving under the influence, the Justice Department claimed. He was forced to go through withdrawal from his opioid use disorder medication while incarcerated in 2019 for an unrelated probation violation.
Afterward, the DUI court did not allow him to resume taking his prescribed medication, according to the federal agency.
“Fearing relapse, and with no alternative, Complainant F resumed taking his prescribed buprenorphine,” attorneys for the Justice Department wrote.
That decision led to a parole violation charge in 2019, being incarcerated for one month, and spending another month in inpatient treatment, according to the amended complaint.
In an August legal filing seeking to dismiss the complaint, attorneys representing Pennsylvania’s court system, the state Supreme Court, and the local courts did not directly address the allegations of harm for the complainants in those counties. Instead, they made procedural arguments for the claims against the county courts.
The Justice Department has also raised concerns about current or recent policies in seven other counties, which the federal agency said imposed categorical bans and limitations on access to opioid use disorder medication: Allegheny, Berks, Butler, Clinton, Delaware, Luzerne, and York. The federal agency did not name those specific court systems as defendants. Officials in those counties also declined to comment for this story, citing the litigation.
In recent years, some counties have lifted restrictions on medications for opioid use disorder, said Jordan Scott, an official with the Pennsylvania Harm Reduction Network. She hopes this Department of Justice case will lead others to do the same.
She also hopes it leads to an education campaign that explains how these drugs work and pushes back on what she described as false information about them, like the idea that people who use them are just trading one drug for another.
“While everybody has their right to their personal opinion, you don’t have a right to put your personal opinion above research and science,” Scott said.
90.5 WESA partners with Spotlight PA, a collaborative, reader-funded newsroom producing accountability journalism for all of Pennsylvania. More at spotlightpa.org.
